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EX Basics of Mechanical Ventilation

This document provides an overview of mechanical ventilation including: 1. It discusses the physiologic effects of mechanical ventilation and basic modes including volume-controlled ventilation, pressure-controlled ventilation, and pressure support ventilation. 2. It covers ventilator-induced lung injury risks like volutrauma, barotrauma, and atelectrauma and emphasizes using low tidal volumes to prevent injury. 3. It lists indications for mechanical ventilation like increased work of breathing, neuromuscular weakness, hypoxemia, and airway protection and discusses initial ventilator settings and common alarm types.

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Nahom Girma
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129 views32 pages

EX Basics of Mechanical Ventilation

This document provides an overview of mechanical ventilation including: 1. It discusses the physiologic effects of mechanical ventilation and basic modes including volume-controlled ventilation, pressure-controlled ventilation, and pressure support ventilation. 2. It covers ventilator-induced lung injury risks like volutrauma, barotrauma, and atelectrauma and emphasizes using low tidal volumes to prevent injury. 3. It lists indications for mechanical ventilation like increased work of breathing, neuromuscular weakness, hypoxemia, and airway protection and discusses initial ventilator settings and common alarm types.

Uploaded by

Nahom Girma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Addis Ababa University

Department of
Anestisiology

Basics Of Mechanical
Ventilation
By Dr. Nahom Girma
ACCPM/R
Moderator : Dr. Semira /(MD,Assistant Professor of
1
ACCPM,Consultant Anestisiologist)
Outline
• Physiologic Effects of Mechanical Ventilation
• Phase Variables
• Basic Modes of Ventilation
• ventilator-induced lung injury
• Indications and Contra-Indications Mechanical Ventilation
• Alarm
• Initial Ventilator Settings
Physiologic Effects of
Mechanical Ventilation

• Balance between lung recoil inward and chest wall


recoil outward determines lung volume at end of
expiration

• To inflate lungs, Ptp must increase


Ptp = Palv− Ppl

• To increase Ptp, either decrease Ppl (spontaneous


breathing) or increase Palv (positive pressure
ventilation)
• Shunt
Positive pressure ventilation usually decreases
shunt and improves arterial oxygenation.
But PPV also causes
increase pulmonary vascular resistance
• Dead space
If dead space is increased, a higher VE is
required to maintain the same level of VA.
Cardiac Effects
• Positive pressure ventilation can decrease
cardiac output, resulting in hypotension and
potential tissue hypoxia.
• This effect is greatest with high mean airway
pressure, high lung compliance, and low
circulating blood volume.
• Renal Effects
Urine output can decrease secondary to mechanical
ventilation.

• Gastric Effects

• Neurologic Effects
Delirium is common in mechanically ventilated patients.

• Neuromuscular Effects
I f the respiratory muscles are not used during mechanical ventilation (ie,
paralysis), ventilator-induced diaphragm dysfunction can occur.
Phase Variables

Ventilator phase variables:


• Trigger: when inspiration begins
• Target: how flow is delivered during inspiration
• Cycle: when inspiration ends
• Baseline: proximal airway pressure during
expiration
Trigger
Time Trigger
Control breath = ventilator-triggered breath
Trigger variable for control breath = Time

Patient Trigger
Assist breath = patient-triggered breath
Trigger variable for assist breath = Pressure or Flow

Assist-Control
A/C combines two triggers: patient trigger (assist) and ventilator
trigger (control)
Assist-Control
Target
• Target variable can be flow or pressure
Flow Target
Flow is selected as the independent variable.
• The ventilator simply delivers the flow as set by the
provider.
Pressure Target
PAW is selected as the independent variable.
• The ventilator delivers flow to quickly achieve and
maintain proximal airway pressure during
inspiration.
Cycle
The variables most commonly used for the cycle include
volume, time, and flow
Baseline
The baseline variable refers to the proximal airway pressure
during the expiratory phase.
Basic Modes of Ventilation

• Volume-Controlled Ventilation
• Pressure-Controlled Ventilation
• Pressure Support Ventilation
Volume-Controlled Ventilation

VCV is a flow-targeted, volume-cycled mode

• ventilator delivers a set flow waveform pattern


to achieve a set tidal volume.

• The pressure waveform will vary depending on


characteristics of the respiratory system and
patient respiratory effort
Pressure-Controlled Ventilation
• PCV is a pressure-targeted, time-cycled mode
of ventilation

• ventilator delivers flow to quickly achieve and maintain


a set proximal airway pressure for a set amount of time.

• The flow waveform will vary depending on


characteristics of the respiratory system and patient
respiratory effort.
Pressure Support Ventilation
• PSV is a pressure-targeted, flow-cycled mode of
ventilation
• ventilator delivers flow to quickly achieve and
maintain a set airway pressure until the
inspiratory flow depreciates to a set percentage
of peak inspiratory flow.
• The flow waveform, tidal volume, and inspiratory
time vary depending on characteristics of the
respiratory system and patient respiratory effort
Recap
VCV,PCV and PSV
• VCV and PCV: inspiratory time cannot vary from
breath to breath

• PSV: inspiratory time can vary from breath to breath

• VCV and PCV use A/C trigger

• PSV uses only patient assist trigger


ventilator-induced lung injury

• Volutrauma
• Barotrauma
• Atelectrauma
• Auto PEEP
Volutrauma

• Higher tidal volumes result in increased


stretch of the lung parenchyma.
• Tidal volume should be ≤ 6 mL per kg of ideal
body weight to prevent volutrauma in ARDS
Barotrauma
Excessive airway pressure in the alveoli can lead
to complications such as
• pneumothorax,
• pneumomediastinum, and
• subcutaneous emphysema.
Atelectrauma
• Atelectrauma: lung injury from repetitive opening
and closing of alveoli

• PEEP can minimize atelectrauma by preventing


closure of open alveoli

N.B=PEEP may paradoxically worsen gas exchange


and decrease lung compliance by causing alveolar
over distension
Indications for Mechanical
Ventilation

Mechanical ventilation reduces work of


breathing by providing the driving force for
inspiration
• Increased Work of Breathing
( the resistive component and the elastic
component)
• Increased Demand
• Neuromuscular Weakness

• Alveolar Hypoventilation
(won’t breathe or can’t breathe)
drug-induced sedation, central nervous system disorders,
or profound systemic disorders such as circulatory shock and metabolic
encephalopathy

• Hypoxemia
Alveolar hypoventilation
Low PIO2
V/Q mismatch
Shunt
Diffusion abnormality

• Airway Protection
Objectives of mechanical ventilation
Initial Ventilator Settings
• Mode
A/C , VCV/PCV and PSV

• Volume and Pressure Levels


plateau pressure < 30 cmH20 unless chest wall compliance
is reduced.
(depends on the tidal volume delivered)

Tidal Volume 4 -8 mL/kg ideal body weight (IBW) .


• Flow Pattern, Peak Flow, and
Inspiratory Time
Peak flow should be set initially to produce an
inspiratory time less than or equal to 1 second

Inspiratory time should be set so that it is less


than the expiratory time to avoid air trapping
and hemodynamic compromise.
• Rate
Adjustments to rate are made after monitoring the effect of
mechanical ventilation.

The rate chosen depends on tidal volume, pulmonary


mechanics, and Pa C02

• FIo2 and PEEP


At initiation of mechanical ventilation, FI02 of 1.0 is
recommended

An initial PEEP of 5 is set to maintain functional residual


capacity and prevent atelectasis.
Ventilator Alarm
There are several different types of ventilator alarms, including the
following:

• ŸHigh OR ŸLow Pressure

• ŸLow Volume

• ŸHigh Frequency

• ŸApnoea

• ŸHigh OR ŸLow PEEP


High OR Low Pressure Alarm
• Triggered whenever the circuit pressure exceeds a preset
pressure limit during the inspiratory phase of breathing.

ŸCauses:-
Coughing
Secretion accumulation
Biting the endotracheal tube
Kinking in the circuit or artificial airway

• Low Pressure Alarm most commonly occurs whenever


there is a leak or disconnection in the system.
Low Volume Alarm
• Causes same as low pressure alarms

High Frequency Alarm


• incorrect sensitivity setting Or Respiratory distress

Apnoea Alarm
• most commonly occurs whenever there is a disconnection of the circuit from
the endotracheal tube.
High PEEP Alarm
• Caused by many of the same problems that
activate the high pressure alarm.
• Sounds whenever auto-PEEP or air trapping is
present
LOW PEEP Alarm
• Caused by many of the same problems that
activate the Low pressure/Volume alarm.
• Sounds whenever a leak in the circuit tubing
or endotracheal tube cuff

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